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Editors Selection IGR 7-3

Surgical Treatment: Can ARBs Inhibit Fibrosis?

Comment by Ernst Tamm on:

76926 Inhibitory Effects of Angiotensin II Receptor Blockade on Human Tenon Fibroblast Migration and Reactive Oxygen Species Production in Cell Culture, Kim D; Pattamatta U; Kelly E et al., Translational vision science & technology, 2018; 7: 20

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There is considerable evidence showing that the renin angiotensin system (RAS) is not limited to its endocrine physiologic role controlling blood pressure, electrolytes, and fluid homeostasis. In addition, it plays an important role in wound healing, fibrosis, and inflammation.

Renin angiotensin system plays an important role in wound healing, fibrosis, and inflammation

The principal effector of the RAS, angiotensin II, acts mainly via the angiotensin receptor 1 (AT1R). Kim an coworkers followed up on the hypothesis that the RAS is involved in postoperative wound healing in the human eye, and that its blockade may modulate fibroblast activity in the context of postoperative wound healing in glaucoma filtration surgery. The authors investigated the effects of angiotensin receptor blockade on the migration of human Tenon fibroblasts (HTF), using Irbesartan, an angiotensin II receptor type 1 (AT1R) blocker (ARB) as a potential antifibrotic agent in glaucoma filtration surgery. In HTF cell cultures Irbesartan inhibited HTF migration by 50% to 70% compared to controls. Irbesartan reduced cell numbers by 50%. Conversely, angiotensin II increased cell numbers up to four-fold while retaining cell viability. All in all, the findings are in line with previous studies showing that Losartan, the first approved AT1R blocker attenuates scar formation after trabeculectomy and that Olmesartan, another angiotensin receptor blocker (ARB), also inhibits fibroblast proliferation. This elegant study clearly suggests a potential therapeutic strategy using AT1R blocker after filtration surgery, an approach that is certainly worthwhile to pursue. Having said this, it should be taken into account that the study is currently limited in its nature as it is only based on cell culture experiments. Clearly, wound healing after trabeculectomy is a process that is under the influence of a multitude of factors including not only HTF but also cells of the immune system, factors released from aqueous humor or blood vessels and many more. The next logical step is now to bring those culture experiments to an experimental level that investigates the effects of Irbesartan in the living eye.

The next logical step is now to bring those culture experiments to an experimental level that investigates the effects of Irbesartan in the living eye

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